Robotic Approach to a renal artery aneurysm in an eight-year old child

KS Awards Finalist 8: This video is one of the 8- Finalists in consideration for the top three prizes to be announced February 6th, 2021: Renal Artery Aneurysm in a Severely Hypertensive Child Robotic Nephrectomy With IVC Mobilisation; Sripathi V, Ganesan T, Rajiv P Apollo Children’s Hospitals, Chennai

Introduction: This video demonstrates the approach to a renal artery aneurysm in a severely hypertensive child with renal artery stenosis and a defunct kidney.

Materials and Methods: An eight-year old female child presented with severe headache, bilateral papilloedema, MRI evidence of demyelination and accelerated hypertension which needed five drugs for normalisation. There was a bruit over the right renal area with a very high Plasma Renin Activity. Contrast Enhanced CT scan revealed a 4 cms aneurysm of the renal artery with a poorly functioning right kidney. Robotic nephrectomy was planned and the challenge was to access and clip a 5 mm stump of the juxta-aortic renal artery before safely handling the aneurysm. The aneurysm was found to be densely adherent to the anterior wall of the Infereior Vena Cava (IVC) and aorta. To expose the renal artery take off, the IVC had to be lifted after dividing and clipping the first and second lumbar veins. Once the renal artery was clipped the IVC could be rolled away from the aneurysm and renal vein clipped and divided. Residual attachments to the aorta were divided. The procedure was completed in 120 minutes with no blood transfusion. On follow-up eight weeks later, hypertension is under control with one drug and child is symptom free.

Results: Freeing the IVC to approach the aorta and the renal artery take off involves meticulous dissection. We used the Da Vinci Robot to clip the renal artery stump and thereby safely dissect the aneurysmal attachments.

CAUTION: contains narrated presentation of PowerPoints, Photos, Diagrams and robotic surgery footage, 08:04.